title: Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers' attitudes, knowledge, confidence, and practice in humanitarian settings.
abstract: BACKGROUND
  Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers' attitudes, knowledge, confidence, and practices in four countries.
  
  
  METHODS
  Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers' practice. Quantitative and qualitative data underwent statistical and thematic analysis.
  
  
  RESULTS
  While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p < .01) and 74% to 81% (p < .05) respectively. Healthcare providers' knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p < .001) and 58% to 73% (p < .001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p < .01), HIV post-exposure prophylaxis from 42% to 92% (p < .001), and STI prophylaxis and treatment from 45% to 96% (p < .01).
  
  
  CONCLUSIONS
  Although beliefs about sexual assault are hard to change, training can improve healthcare providers' respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.
authors.affiliation: International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.
authors.forename: Janel R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA ; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Lara S
authors.initials: LS
authors.lastname: Ho
authors.affiliation: International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Langston
authors.affiliation: Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Mankani
authors.affiliation: International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.
authors.forename: Anjuli
authors.initials: A
authors.lastname: Shivshanker
authors.affiliation: International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA.
authors.forename: Dhammika
authors.initials: D
authors.lastname: Perera
keywords: Democratic Republic of Congo (DRC); Ethiopia; Healthcare provider; Humanitarian; Jordan; Kenya; Refugee; Sexual and Gender Based Violence (SGBV); Sexual assault; Training